End-of-life decisions are gut-wrenching.
That’s why it’s important to have current information and communicate.
Knowing your elder’s wishes makes difficult choices possible. If you are in the position of making a decision for someone who isn’t able to tell you their wishes, having clear, up-to-date information gives you the best tools.
DNR (Do Not Resuscitate)
A DNR is a form signed by your doctor at your (or your elder’s) request. It indicates that if your heart stops, or you stop breathing, you don’t want to have CPR (cardio-pulmonary resuscitation) performed on you.
At face value, it looks like a bad idea. Why would anyone not want to be resuscitated?
- Unlike in the movies, CPR does not usually return you to your former level of functioning.
- Chest compressions can (and often does in the elderly) lead to broken ribs, which can then puncture a lung.
- Many times, CPR leads to other invasive procedures, such as ventilation.
- Sometimes brain damage results from lack of blood flow.
- Even if the heart is restarted, the survival rate is poor.
A 2021 review looked at research published from 2008 onward that focused on the outcome of CPR in patients age 70 and older following in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Survival rates were 28.5% and 11.1%, respectively.
Other directives (Levels of Care, POLST (in the U.S.) and Living Wills)
The bottom line is to let others know your wishes. If you aren’t going to get better, how would you like to live your last days?
You may have heard of a Living Will (which I was interested to find out is not a legal term in Ontario.) In long-term-care homes, they often have some version of “levels of care,” which indicates what kind of treatment the elder or their power of attorney sees for their future. These are reviewed yearly or if a significant change occurs in the resident’s medical status.
In many states in the U.S., a document called POLST is available, which is a comprehensive plan of care for your last days. Although this document is specific to the U.S., this video looks at both medical and non-medical life decisions. Some may surprise you.
A lot to think about? For sure. If it’s possible, start having these conversations in small, meaningful ways.
Today.
- https://www.verywellhealth.com/hands-off-do-not-resuscitate-1132382
- https://www.youtube.com/watch?v=_engOzyc-7M
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